Article Abstract

Article Abstract

Online ISSN: 1099-176X Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 22, Issue 1, 2019. Pages: 3-13
Published Online: 1 March 2019

Cost Savings from a Navigator Intervention for Repeat Detoxification Clients

Dominic Hodgkin,¹* Mary F. Brolin,² Grant A. Ritter,³ Maria E. Torres,⁴ Elizabeth L. Merrick,⁵ Constance M. Horgan,⁶ Jonna C. Hopwood,⁷ Natasha De Marco,⁸ Andrea Gewirtz⁹

¹Ph.D., Professor, Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
²Ph.D., Scientist, Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
³Ph.D., Associate Research Professor, Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
⁴Ph.D., Assistant Professor, Smith College School for Social Work, Northampton, MA, USA
⁵Ph.D., Senior Scientist (retired), Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
⁶ScD, Professor, Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
⁷JD, LICSW, Director of Addiction Services, Massachusetts Behavioral Health Partnership, a Beacon Health Options company, Boston, MA USA
⁸MPH, Senior Project Manager, Massachusetts Behavioral Health Partnership, a Beacon Health Options company, Boston, MA, USA
⁹LICSW, Vice President of Statewide Specialty Services, Massachusetts Behavioral Health Partnership, a Beacon Health Options company, Boston, MA, USA

* Correspondence to: Dominic Hodgkin, Brandeis University, 415 South Street, MS 035, Waltham, MA, 02453, USA.
Tel.: +1-781-736 8551
Fax: +1-781-736 3985
E-mail: \underlinehodgkin@brandeis.edu

Source of Funding: This study was supported by award number 1C1CMS331059-01-00 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies. The research presented here was conducted by the awardee. Findings might or might not be consistent with or confirmed by the findings of the independent evaluation contractor.

Abstract

Many clients with substance use disorders (SUD) have multiple admissions to 24-hour detoxification without ever progressing to SUD treatment. This outcome is costly and ineffective. We studied an intervention to connect frequent detox patients with SUD treatment, in the Massachusetts Medicaid population. The intervention used Recovery Support Navigators, whose services were funded using a flat daily rate per client, and clients were offered incentive payments for meeting milestones to reinforce recovery-oriented behaviors. Health care spending grew 1.6 percentage points more slowly for intervention-enrolled members than for others, implying gross savings of $68 per member per month. After subtracting intervention-related costs, estimated net savings were $57 per member per month. The intervention was also associated with shifts in the health care service mix from more to less acute settings. These results suggest some potential for payers to reduce the health care costs associated with repeat detox by using a navigator-based intervention.

Background: Many clients with substance use disorders (SUD) have multiple admissions to a 24-hour level of care for detoxification without ever progressing to SUD treatment. In the US, health insurers have become concerned about the high costs and ineffective results of repeat detox admissions. For other diseases, health systems increasingly target high-risk, high-cost patients with individually tailored interventions delivered by `navigators' who help patients negotiate the complex health care system. Patient incentives are another increasingly common intervention.

Aims of the Study: (i) To examine how health care spending was affected by an intervention intended to improve entry to SUD treatment among clients who had multiple detox admissions. (ii) To see whether spending effects, overall and by type of service, differed by intervention arm. (iii) To assess whether the intervention resulted in net savings from the payer perspective, after subtracting implementation costs.

Methods: The intervention was implemented in a segment of the Massachusetts Medicaid population, and used Recovery Support Navigators (RSNs) who were trained to effectively engage and connect clients with SUD to follow-up care and community resources. Services were funded using a flat daily rate per client. Additionally, in one of the two intervention arms, clients were offered successive incentive payments for meeting pre-specified milestones to reinforce recovery-oriented behaviors. For this paper, multivariate analyses of claims and administrative data were used to measure the intervention's effect on health care spending, and to estimate net savings to the payer.

Results: Health care spending grew 1.6 percentage points more slowly for intervention-enrolled members than for others, implying gross savings of $68 per member per month. After subtracting intervention-related costs, net savings were estimated at $57 per member per month. The intervention was also associated with shifts in the health care service mix from more to less acute settings.

Discussion: While the results for total spending did not reach statistical significance, they suggest some potential for insurers to reduce the health care costs associated with repeat detox utilization by using a navigator-based intervention. Analyses reported elsewhere found that this intervention had favorable effects on rates of initiation of SUD treatment. Limitations of the study include the fact that neither subjects nor sites were randomized between study groups; lack of data on crime or productivity outcomes; low participant use of RSN services; and a policy change which altered the participant pool and truncated follow-up for some.

Implications for Health Care Provision and Use: These results suggest some potential for payers to reduce the health care costs associated with repeat detox by using a navigator-based intervention. To the extent that this results in shifting resources from repeat detox to actual treatment, the result should provide longer term benefit to the population coping with SUD.\underline

Implications for Health Policy: These results may encourage Medicaid and other payers to further experiment with similar interventions using navigators to decrease health care costs and improved the lives of SUD patients.

Implications for Further Research: It could be informative to test similar navigator interventions for detox patients in other settings where enrollment periods are longer.

Received 12 March 2018; accepted 5 December 2018